Although this is very disturbing to many patients, this is not really a
complication or a risk, as rippling will occur with all implants.
All breast implants
has rippling or wrinkling to some degree. Implants, whether they are
saline or silicone are all susceptible to rippling – either palatable or
visible. The degree of rippling or wrinkling is based on several
factors that work to help hide the rippling or factors that will
contribute to this.

Rippling happens when the filling material, either saline or silicone;
inside a breast implants shifts and allows for a fold or a wrinkle to
appear on the outer shell. Unfortunately sometimes this shows up
as a bump or a ridge – and can be felt and in bad situations, seen on
the surface of the breast. Silicone implants tend to have less
rippling than saline, however even silicone is not exempt from this.
A lot has to do with whether the implants are placed over the muscle or
under the muscle as well as the surface of the implant.
Textured
implants because of their ability to grab onto the tissue are more prone
to rippling than smooth shell implants because of the fact they are more
palpable.

Silicone implants that are placed under the muscle will give the patient
much better odds of rippling not to happen, especially in thin skin
patients with little body fat. The thickness and quality of the
patient’s skin will determine the amount of rippling.

Implants tend to ripple more
near the cleavage (where the skin is thinner) and near the outside area towards
the arm. For patients who have “Partial Sub-Muscular” implant placement, and
who have thin or non-existent tissue to start with, the bottom portion of the
breast can also get some rippling. Partial sub-muscular placement utilizes the pectoralis muscles with covering 2/3 of the implant. This top 2/3 of the
implant is hidden behind the muscle, making rippling or wrinkling less likely.

Patients who have little to
no tissue to start the breast augmentation out with are normally discouraged to
having over the muscle placement, as there is no layer helping with hiding the
implant edges.

Another factor that contributes to implants rippling or
wrinkling is not utilizing the optimum fill rate of the device. Sometimes in
order to get the optimum fill rate, this will mean that the plastic surgeon will
need to overfill the implant passed the manufacturer’s stated amount. Overfill
is the volume added to an implant that is more than the manufacturer's
MAXIMUM limit.

On all breast implant pamphlets it clearly states:

“Follow the recommendation on the product
data sheet for fill volume; do not overfill or under-fill the implant”.

The difference between
inadequate volume and the optimal volume is amazingly small, somewhere around
10%, which equates to only a couple tablespoons of water.

Optimal fill helps the
implants last longer, even though that may exceed the manufacturer's maximum,
and of course it helps with wrinkling and rippling. It has been studied
extensively that wrinkling of a breast implant can and does lead to premature
failure by causing high stress folds and wrinkles. The studies have confirmed
that optimal filling by reducing the wrinkling can and does actually help the
implant last longer.

Optimal Fill Ratio also
targets too much “over-fill” in the saline implant. Just like under-fill,
overfilling too much can actually cause the implant edges to scallop (uniformed
wrinkles all around the edge).

Textured implants were
primarily designed to prevent the complication of Capsular Contracture. There
are many studies concerning this subject matter on whether or not the textured
surface is really efficient in preventing capsular contracture. Some studies
have shown that implants that are placed under the muscle, there is no
difference in the complication of capsular contracture rates, while others show
a much lower rate of this problem occurring.

Traction rippling is not
considered a complication, rather a visible surface feature.

A textured surface implant,
whether it is saline or silicone can produce traction rippling because of the
manner in which the textured surface is incorporated into the surrounding
tissue. Implants can change shape or position due to changes in the body
position. Because of the phenomena that occurs with texture implants pulling
the surround tissue (the capsule) – this can in turn pulls on the skin as it
falls to the bottom of the pocket. It is this pull that produces the traction
rippling.

Only the use of smooth implants eliminates this risk.

Traction rippling normally occurs on a thin patient that
has little to no tissue and they might be able to feel the implant on the side.
Traction rippling has a uniformed pattern with how it appears through the
tissue, and this can appear “wave-like”.

Traction rippling can occur
with an implant over or under the muscle. If the patient has partial
sub-muscular placement, then the rippling may not be visible in the upper
portion of the breast, but it will be noticeable on the lower pole area where
the implant is only covered by tissue.